May 30 (Bloomberg) -- For the leading Democratic presidential hopefuls, making health care more affordable is a tale of two villains. Barack Obama is targeting drugmakers, while Hillary Clinton is taking aim at insurers.

Obama, who presented his health plan yesterday, wants the U.S. to negotiate drug price-discounts for Medicare, the national program for the elderly and disabled, spur wider use of cheaper generic copies of pharmaceuticals and allow Americans to buy lower-priced medicines from Europe and Canada. Clinton plans to bar insurers from ``cherry picking'' who they sign up and block them from charging higher rates to those in ill health.

Aside from the different culprits they emphasize, Obama and Clinton are offering similar solutions to lower the $2.1 trillion annual health bill in the U.S. and provide insurance for every American. Candidate John Edwards, who is proposing many of the same ideas, says medical coverage can be extended to the nation's 45 million uninsured by simply allowing them to sign up for Medicare or another government-run plan.

``What's important about the proposals is that the major Democratic candidates are in agreement on what shape health-care reform should look like,'' said Robert Blendon, a professor of health policy at Harvard University. ``These are centrist proposals to address the uninsured with a strong focus on reducing future health-care costs.''

Republican candidates have yet to focus on the issue, allowing the Democrats to differentiate their party, if not the specific candidates' plans. President George W. Bush has called for tax incentives and health savings plans to encourage more Americans to buy medical insurance.

Republicans' Views

``The Republicans, like Democrats, understand that the system suffers from a problem, but I think they see the solution in a very different direction,'' said Henry Aaron, a health policy analyst at the Brookings Institution in Washington. ``They talk about free markets and power of improved incentives, but they're not really focusing on aggressive measures directly to extend coverage.''

The emphasis on health care by the leading Democratic candidates mirrors the concerns of U.S. voters. Polls show medical costs are a leading domestic worry for Americans, whose health insurance premiums are rising at double the rate of their wages, according to the Henry J. Kaiser Family Foundation, a health policy and research organization in Menlo Park, California.

``What you will see in the next election if Democrats win is a big emphasis on health reform,'' Aaron said. ``As the candidates have clearly demonstrated, they understand the importance of the issue.''

Mandatory Coverage

One difference among the Democrats is whether all Americans should be required to have health insurance. Obama said he would mandate coverage only for children.

Edwards has proposed mandatory insurance for everyone, and Clinton's campaign said Obama didn't go far enough. ``We have to achieve true universal healthcare so that every American has health care coverage,'' said Neera Tanden, the campaign's policy director, in a statement yesterday.

Senator Obama of Illinois and Edwards, a former North Carolina senator, would pay for their health-care plans by not renewing Bush's tax cuts for the wealthiest Americans and by requiring employers to provide benefits to their workers or contribute to a fund to cover the uninsured. Clinton hasn't yet said how she'd pay for universal coverage.

Finding Savings

All three Democrats say their plans depend partly on cost reductions.

Senator Clinton of New York said May 24 that her proposal could save $120 billion annually, thanks to better care of chronic diseases and setting up an institute to make sure hospitals and doctors provide quality care. Obama said each American family may save $2,500 a year under his plan.

The two candidates, like Edwards, say their plans will produce savings from improved health information technology. This may reduce wasteful tests by allowing doctors to share medical records, the three candidates say.

Employing electronic record-keeping is an idea that has been discussed for years, including by Bush. The savings may not be as quick or as generous as the candidates suggest, said Robert Laszewski, a health-care consultant in Alexandria, Virginia.

``The notion that this will make U.S. health care affordable in their first term is really naive,'' Laszewski said in an interview yesterday. ``These are all positive things to do, but return on investment comes slowly.''

To contact the reporter on this story: Aliza Marcus in Washington at amarcus8@bloomberg.net

Last Updated: May 30, 2007 11:10 EDT